American Journal of Forensic Medicine and Pathology最新文献

While fat embolism commonly occurs following fractures of the long bones and the pelvis, it is also frequently reported after procedures such as hip or knee arthroplasty and intramedullary nailing. Contributing risk factors include obesity, immobilization, and osteoporosis. In contrast, its association with vertebral fractures is exceptionally rare. We hereby report an unusual case of fat embolism following an anterolisthesis and a right facet joint fracture of the C5-C6 vertebra. The review of literature reports only four cases in which the fat embolism was seen associated with vertebral compression or displacement fractures. Fat embolism following an isolated facet fracture of the vertebra has not been reported so far. Through this case report, we address a rare yet important association between fat embolism and vertebral fracture.

High-voltage electrical arc injuries are a severe occupational hazard, but fatal cases involving a "near-contact" or "contactless" mechanism are sparsely documented and prone to misinterpretation. We present a case that integrates forensic engineering analysis with pathognomonic autopsy findings to provide a clear diagnostic reference. A 51-year-old male painter was found in cardiorespiratory arrest while using an aluminum pole to paint a commercial facade. A forensic engineering examination revealed the pole was within 170 cm of a high-voltage power line. The autopsy revealed classic electrical entry and exit wounds alongside a distinct thermal burn on the right flank. The integration of scene measurements and specific autopsy findings suggests death by electrocution via a near-contact electrical arc. The thermal burn illustrates a secondary injury mechanism from the arc flash. This case provides a clear methodological and pathological framework for diagnosing these complex occupational fatalities, where the absence of evidence of direct contact or the presence of associated thermal burns can be misleading.

Right atrial perforation is a rare sequela of a few clinical situations, such as acute myocardial infarction, invasive cardiac procedures, or cardiac malignancies. This case is a novel example of a right atrial perforation due to methamphetamine-associated cardiomyopathy. The decedent was a 44-year-old male with a history of methamphetamine use who suffered a witnessed collapse and was pronounced on scene. His autopsy showed findings consistent with acute and chronic sympathomimetic drug use, such as cardiomegaly with dilated cardiomyopathy, necrosis, perforation of the right atrium, and hepatitis. Toxicologic evaluation revealed methamphetamine and benzoylecgonine. Eight hundred milliliters of bloody fluid was removed from the pericardial space. On histologic examination, the right atrium demonstrated acute hemorrhage, mild to moderate patchy fibrosis with myocyte necrosis, and mixed acute and chronic inflammation. The cause of death was classified as cardiac tamponade secondary to a right atrial perforation. Searches of PubMed and Google Scholar failed to provide a report of this complication. This case provides an example of a rare and possibly novel cardiac pathology that occurred as a complication of methamphetamine-associated cardiomyopathy.

Pesticide poisoning remains a major global health concern, with low and middle-income countries like South Africa bearing a disproportionate burden. This retrospective, cross-sectional study analyzed 173 suspected pesticide poisoning deaths investigated at the Pretoria Medico-Legal Laboratory from January 2016 to December 2020. Most decedents were male (69.9%), with a mean age of 31 years; 85% were between 18 and 65. Foreign nationals comprised 12% of cases, and deaths peaked during winter (31% from June to August). Over half were referred from health care facilities, and 95% died within 24 hours of admission. Common autopsy findings included black, pepper-like granules in the gastrointestinal tract (89%), pulmonary froth (63%), and fecal soiling (14%). Toxicology was requested in 170 cases, but 86% remained pending; among 24 completed reports, 71% were positive for Terbufos. Pseudocholinesterase was measured in 39 cases, with levels reduced in 98% (mean = 1493 U/L). Histology most often showed intra-alveolar edema (83%) and pulmonary venous congestion (60%). The findings suggest that a combination of gross autopsy features, depressed pseudocholinesterase levels, and supportive histology may reliably indicate pesticide poisoning, even in the absence of timely toxicology results. The recent ban on Terbufos provides a key opportunity for future public health evaluation.

The National Association of Medical Examiners (NAME) convened a panel to create a position paper for the investigation of pediatric deaths due to suspected inflicted head trauma. The certification of both the cause and manner of death is dependent upon an evaluation of all available data including information derived from the investigation, scene, postmortem examination, and ancillary studies. This paper provides the forensic pathologist with a comprehensive review for the postmortem examination of infants and toddlers who have died or have apparently died of inflicted head trauma. Specifically, this paper describes (1) procedures, (2) ancillary laboratory tests, and (3) forms of documentation that may be important in the investigation of these deaths. Some of these techniques are highly specialized and are performed at the discretion of the prosector. The evaluation and documentation of such fatalities involves the production of a reviewable, objective data set to support the multitude of inquiries that may follow from the public and the criminal justice system.

The Karl Hopf case (1913-1914) represents the first thoroughly documented European instance of biocrimeintentional poisoning, using live bacterial cultures for criminal purposes. This study examines the forensic significance of the case, including the application of microbiological agents as instruments for homicide and the pioneering forensic use of the Widal seroreaction test to establish a causal link between pathogens and victims. The successful detection of arsenic in the cremated remains further expands the scope of postmortem toxicological analysis. The case catalyzed legislative reform in Germany, prompting stricter regulations on the sale and distribution of pathogenic microbes. Beyond its scientific impact, the Hopf case entered psychoanalytic discourse through Freud and Reik's interpretation of Hopf's linguistic slip and influenced popular culture, notably Arthur Conan Doyle's "The Adventure of the Dying Detective." Unlike other suspected microbial poisoning cases in Europe and the United States, the Hopf case remains the only one to receive sustained and detailed coverage in the criminological and forensic literature. Bridging forensic innovation, legal reform, and cultural reflection exemplifies how a single criminal investigation can redefine evidentiary standards and shape interdisciplinary understanding of crime in the modern era.

Streptococcus pyogenes [group A strep (GAS)] is not a novel pathogen, but it is a newly emerging deadly threat. Recent data suggests that GAS, like many other contagions, saw a rise in infections in 2022, likely due to the withdrawal of COVID-19 precautions. GAS can present as a localized infection, namely tonsillopharyngitis, impetigo, cellulitis, and scarlet fever, or as an invasive infection such as meningitis, pneumonia, necrotizing fasciitis, and puerperal sepsis. Even though GAS tonsillopharyngitis is not typically fatal, it can be complicated by acute rheumatic fever if antibiotics are not administered promptly. Though the prevalence of acute rheumatic fever (ARF) and its sequelae, rheumatic heart disease (RHD), has declined over the last half-century in Europe and North America, ARF and RHD both remain some of the most significant contributors to cardiovascular morbidity and mortality among socially and economically disadvantaged populations globally. Here we present 2 cases of fatal invasive GAS infections in previously healthy young adult males, with diagnoses made postmortem due to a lack of clinical recognition prior to death.

In gunshot-related deaths, measuring upper limb lengths is commonly performed. At postmortem examination, the upper limbs are commonly flexed from rigor mortis, and, for convenience, lengths are sometimes measured flexed. However, it is unclear whether there is a difference between the upper limb lengths when measured flexed and extended and placed in the standard anatomic position. This prospective study compared the upper limb length in 30 adults when the upper limb was in rigor mortis and flexed to when rigor mortis was broken, upper limbs extended and placed in standard anatomic position. In the first 20 cases, the limbs were measured without passing through the same bony landmarks and showed that the upper limb length was significantly shorter (mean: 5 cm, maximum: 13 cm, P < 0.05) when rigor was broken, upper limb extended, and placed in standard anatomic position. However, in the remaining 10 cases, when the measurements were taken through same bony landmarks (acromioclavicular joint, lateral epicondyle, posterior wrist, and tip of distal index finger phalanges), no significant differences were demonstrated (mean: <0.5 cm, maximum: 3 cm, P > 0.3). The results of this study showed that the standard method (ie, following the same bony landmarks) is needed when measuring upper limb length, especially when it can be in nonanatomical positions at postmortem examination.